Assessment 4 Critical Appraisal Critical appraisal article on “Quality nursing care in the words of nurses” Burhans & Alligood (2010) Journal of advance nursing 66(8). This part will be short description of author’s qualifications, abstract, literature review, which methods was used to reveal answer for the research questions, findings on six essential themes, discussion on responsibility and quality nursing care. The title is clearly defined as research on ‘Quality nursing care in the words of nurses”. This represents the meaning of quality in nurses.
Significantly the authors are highly educated in the relevant field of study. The first author Linda Maas Burhans PhD RN CPHQ is affiliated as Associate Executive director of Education and Practice, North Carolina Board of Nursing and Adjunct Faculty, East Carolina University College of Nursing, Wilson, NC USA. Another author (Martha Raile Alligood) qualifications are PhD RN ANEF Professor and Director of PhD Program affiliated to East Carolina University College of Nursing, Greenville, NC USA. Firstly the aim of the study is quality nursing care for practising nurses.
Patient’s outcome and safety are disturbingly low to the problem. Ideally the topic is narrowed down to a specific one sentence statement of the problem (Nieswiadomy 2012). The question is how to involve nurses in quality of care towards patients and how it could be more effective. Van Manen’s hermeneutic methodology is used to find answers for the research. These problem is clearly identified in particular article, what is the lived meaning of quality nursing care for practising nurses. The aim and problem follows logically throughout the paper.
Yet data was collected (empirical and eflective analysis) by twelve nurses through audiotape and transcripts in 2008. That said, most of the needs are (caring, empathetic, respectful interactions, responsibility) findings these quality in nursing. In conclusion it recommended that nurse managers could develop some strategies such as respect and advocacy to support nurses in their practice and delivering quality of care. Secondly, those nurses are often participants in study measurements. Moreover evidence of their input is lacking, developers and authors of the measures and educators are not involved in nursing practice.
However the quality of caring is not adequately represented. Nurses are playing vital role as nurse in healthcare were it is required to assess, plan and evaluate the care of needs. It is said that “Evidence and research are threaded through practice, professional work and study in the health sciences (Bradshaw 2012, p. 15)”. Secondary sources were used to focus the review where PICO question be developed but it does not address the quality of nursing care specifically. Therefore idea was presented by author to uncover the meaning of quality nursing care as lived, understood, and articulated by practising nurses.
Importance was given to nursevalued measures can only be developed if it is clearly identified (acute care) in USA. However literature is critically appraised that lived meaning of quality nursing care for practising nurse has not specifically identified in literature but qualitative study using van Manen’s hermeneutic phenomenology explored the meaning of care. The aim of the study was to uncover an understanding of the meaning of nursing care. From this hermeneutic phenomenology, providing exploring and gathering experimental resources develop a deeper and richer understanding of human phenomenon.
Phenomenology is a theoretical perspective that attempts to generate knowledge about how individuals experience things (Hesse Biber & Leavy 2011)”. The three main points were discovered through van Manen’s study despite this as follows. (1) Pragmatic process (2) applicability to both the discipline and profession of nursing (3) methodology that honoured the importance of nurses. They have targeted nurses from hospital who are registered nurse in the field having direct contact with patients care, knowledge of medical, working in acute care for at least one year and 20 hours of work weekly.
It was suitable to their needs and requirement to the researchers because it was essential for quality assessment to unpack complex issues. Author continued methodology by renaming with pseudonyms to ensure confidentiality of reports. All participants were female with age of 37. 5 years (range = 25-52 years). Among this seven had practiced for an average of 10 years (range = 4-21 years) at the associated degree nursing (ADN). They also had experienced in assigned unit (mean = 5. 2 years) prior to completing (BSN) degree.
Significantly data collected by tape recorder was 40 minutes above all telephone interview, face-to-face interview conducted privately and confidentiality was maintained. The process of phenomenologic inquiry including empirical and reflective method were collected personally by (LMB). List of cross questions asked by authors to obtain particular answer from experienced nurses. In Comparison data composed of six research activities by analysing and synthesized using van Manen’s method. First activity contains affirming and belief. Second activity explored investigating experience rather than conceptualizing.
Third activity include reflecting on essential themes. Fourth activity describing phenomenon art of writing and rewriting. Fifth activity required to study in nursing discipline and having strong connection between theory and real life. Study text was rich and thick in form of producing, understanding, interpretation. Because the logic of the story is unique, particular, and irreplaceable. Last activity was balanced by context considering the parts and whole. The primary interviewers recorded (reflexive field) notes with threefold purpose.
In theoretical notes observations and meaning captured. Methodological notes details and reminders were recorded. Personal notes recorded feeling, beliefs, biases and thoughts. Verbatim quotes were used as low descriptions. As well as trustworthiness quotes were verified direct by audiotapes and field notes. In depth ethical issues were considered and high priorities given to the study. Institutional review board (IRB) approved study. The head nurse and presidents of the study hospitals supported distributing fliers and seeking volunteers.
On other hand volunteers were given opportunity to withdraw their name at any time before interview and written application also accepted prior to schedule appointment. An illustration, is the case of findings were six essentials themes discovered. (advocacy, caring, Empathy, intentionality, respect, responsibility). Verbatim examples indicated phrases most meaning of quality nursing care. The participants have phrases such dialogues were it is understandable that importance of nursing and quality care responsibilities through skills.
Not only six themes were essential components of the research, but also human part required for skill element. Authors were agreed to researcher’s statement were it suggest that care delivery is valued in in field rather than skills. As well as skills can be learned but quality of care provide necessity of life. We have seen the methods used to find the result. Essence of analyzing iterations and reflective thematic relationship it believed that quality of nursing care can be met by human needs through caring, empathetic, respectful interaction within which responsibility, intentionality and advocacy form and integral foundation.
Art of nursing found by hermeneutic interpretation of writings and conceptual system of Rogers’s science of Unitary Human Beings: Thus, the art of professional nursing becomes the ability to balance respect for human freedom and individual rights with responsibility for the welfare of others through knowing from the feeling attribute of empathy in the moral action that is nursing practice. (Alligood 2002, p. 58). Responsibility, respect and empathy identified as art of nursing and related to the concept of caring.
Earlier literature identified unique of nursing and viewed as essence. In view of authors concept of caring the four of six themes are identified the lived meaning of quality nursing care. By contrast these themes are used to evaluate the quality of nursing care through observation, behavior and interaction with patients. Findings were limited to individual’s interview as all are females who were employed and practising nursing in their nominated area.
The word ‘not generalizable’ is used to define the search population and disagreeing with educational preparation and care delivery. Finally hermeneutic phenomen cal studies are subject to alternative interpretations. In conclusion the evidence point in nursing care has discipline and practice changes, driving improvement in care and outcomes of patients. The report suggest that important finding required in future investigation on three topics mentioned.
Different acute care delivery settings another in non-acute settings and roles in community health care. Last but not least the lived meaning of quality nursing care among male nurses. Author’s contribution were responsible for conception and design of study. Study has been good to authors as they found the methods useful for research and it worked well with six themes and outcomes of questions which developed in beginning. Researcher has related to the meaning, definition and perception of quality care has been limited.
The gaps are found between practising nurse and educators who are not in those field where the skills are developed for further improvement of care. For data collecting the four activities were performed to find accurate data. Trustworthiness quote were verified accurately by audiotape and field notes. Therefore strength and weakness are discussed through the points. No conflict of interest has been declared by authors in research.